Type of Attitude Towards Pregnancy of Women in the Context of a New Coronavirus Infection Caused by COVID-19

Praizendorf Ekaterina Sergeevna Senior Lecturer, Department of Clinical Psychology, Altai State University 656049, Russia, Barnaul, Lenin str., 61, office 309 catherinears@list.ru Other publications by this author     Kuz'mina Anna Sergeevna PhD in Psychology Associate Professor, Department of Clinical Psychology, Altai State University 656049, Russia, Altai Krai, Barnaul, Lenin str., 61 annakuz87@yandex.ru Kulagina Dar'ya Alexeevna Postgraduate student, Department of Clinical Psychology, Altai State University 656049, Russia, Altai Krai, Barnaul, Lenin str., 61 psy.daria.kulagina@gmail.com

Hummel Natal'ya Vladimirovna Assistant, Department of Clinical Psychology, Altai State University 656049, Russia, Altai Krai, Barnaul, Lenin str., 61 nfokina98@mail.ru

The problem of studying the type of attitude to pregnancy of women in the conditions of a new coronavirus infection caused by COVID-19 is an important area of research located at the intersection of medicine, perinatal and clinical psychology. Life in the conditions of the spread of coronavirus infection is associated with instability, nonlinearity and fragility of the world. In conditions of general uncertainty and anxiety, due to frequently changing global trends, with the emergence of a new coronavirus infection, humanity had to face an even greater need to adapt and comprehend the events taking place in terms of adaptation to them and what determines the type of attitude to a woman's pregnancy.

Thus, according to the cognitive-behavioral concept, the perception of the situation and its comprehension have a greater impact on the development of further emotional reactions than the fact of what happened directly. However, it is worth noting that the new normality, new living conditions in the situation of coronavirus infection, can provoke the actualization of not only irrational beliefs, but also early maladaptive schemes, which in turn are comprehensive and entail a number of negative consequences, including irrational emotional response and maladaptive behavioral reactions. 

Research aimed at analyzing coping strategies, thinking patterns in the context of a new coronavirus infection suggests that the degree of successful adaptation to new living conditions is directly related to the characteristics of personal response and the style of perception of reality. That is, the more irrational the beliefs are before encountering a stressful event, the more likely a vivid emotional maladaptive reaction will occur at the moment of stress. Therefore, it seems important to us to study the peculiarities of thinking of pregnant women related to the perception of the world and themselves in this world, in order to minimize negative behavioral and emotional reactions both during pregnancy and after it.

It is fair to note that not only an anxious, fragile, difficult-to-control world can actualize irrational experiences in a pregnant woman. However, the issue of perception of the world as a whole still remains important and relevant, since the more anxious and uncontrollable we are accustomed to consider the world around us, the more difficult it will be for us to focus on daily tasks related to improving our emotional and psychological state. In other words, an irrational assumption may sound like: "Why should I try to change anything in my life if everything around me is constantly changing for the worse."

Of course, it is important to note that the changing reality has an impact on the formation of new ways of responding, new beliefs and patterns, not only in pregnant women. The whole world is faced with the need to find a new approach to experiencing and accepting difficult, disturbing life events ^[1,7]. Taking into account the data of studies aimed at studying the prevalence of various affective disorders, including generalized anxiety disorder, panic disorder, and depression, it should be remembered that for a group of people susceptible to the occurrence of such conditions, the issue of adaptation and the search for new methods of response is most acute ^[3,4,22]. However, it seems to us important and necessary to consider the features of the anxiety response in pregnant women, since pregnancy is a special crisis period, based on the ideas of many authors (G.G. Filippova, I.V. Dobryakov). Moreover, a number of studies show that the possibility of developing affective disorders in the postpartum period is extremely high even without the influence of negative external factors, such as the rapid rate of change of events, the appearance of new disturbing news about the world ^[12,13,14].

A pregnant woman faces instability in the emotional-volitional sphere not only because of the peculiarities of the cognitive organization, but also due to a variety of biologically determined factors ^[15,16]. The conditions of the world, which are alarming and poorly controlled, can not only complicate adaptation directly during the crisis period, but also serve as a source of the formation of new maladaptive symptoms that will have a negative impact both on pregnant women and on the further period after the birth of a child. The more stable the mental state of a woman during pregnancy, the more likely it is to successfully adapt to the new social role of the mother after the birth of a child, reduce the risk of postpartum depression and PTSD symptoms, and nurture a new personality in conditions of successful adaptation to changing realities of life ^[17,19].

The opposite is also true, the more unstable the emotional background, the more pronounced cognitive distortions during pregnancy, the more likely the formation of affective disorders after childbirth. Unfortunately, there are a large number of examples of not timely diagnosis of these negative conditions in a woman, due to various factors, including the mentality of a particular country, family relationships, attitude to a woman after childbirth and living conditions ^[2,6].

The lack of diagnosis and further treatment, in turn, leads to deplorable consequences, including the death of both mother and child. If we talk about less negative consequences, it should be remembered that based on Jeffrey Young's concept, early maladaptive schemes begin their formation in early childhood ^[24]. We can assume that the presence of early maladaptive schemes in the mother, difficulties with adaptation in the new conditions of the organization of the world, irrational cognitive beliefs, will lead to an incorrect parenting style, and as a consequence, the formation of early maladaptive schemes in the child in particular, and in future generations in general ^[8,9]. Therefore, the study, analysis and timely diagnosis of early maladaptive schemes associated with the formation of the type of attitude to pregnancy is an important component in the correction and prevention of negative psychological consequences of pregnancy.

To understand the type of attitude towards pregnancy of women in modern realities, it is worth considering in detail the features of the organization of the world and people's thinking in the conditions of a new coronavirus infection caused by COVID-19. Due to the new life circumstances associated with both coronavirus infection and dramatically changing living conditions, most people began to perceive the world as fragile, nonlinear and incomprehensible. What was previously considered irrational attitudes about the world, according to A. Beck's cognitive-behavioral concept, is now considered beliefs that help with adaptation. If earlier we could say that the world around us can really be controlled and made more understandable, now these theses have lost their relevance. Humanity has to adapt to new, constantly emerging disturbing events faster and faster ^[18].

The anxiety of the world is associated with constantly changing living conditions, the presence of a large amount of information that needs to be comprehended and integrated into your experience.

Previously, a person could roughly predict the course of his further life events, plan important activities for him in advance, understand how his life should look like, now, on the contrary, humanity is faced with the need to adjust its life to an ever-changing world, thereby not being able to plan and organize life in the long term, these features are associated with the nonlinearity of the world.

It is worth noting at once the personality qualities necessary for adaptation in such a complexly organized world. So, fragility can be countered by flexibility and resilience, anxiety – by empathy and awareness, nonlinearity – by understanding the general context of the situation, and incomprehensibility – by maximum transparency and intuition. With the help of work on the development of these qualities, it is possible to exist quite successfully even in such a complex world. The program for the formation of an optimal type of attitude to pregnancy in women should be developed taking into account all the features of adaptation to living conditions in a new coronavirus infection caused by COVID-19 ^[18].

As mentioned above, pregnancy is a special crisis period in a woman's life, the instability of the personal and emotional–volitional sphere is due to a number of factors, including endocrine changes, the formation of a new Self-concept and the acquisition of a new social role. The crisis proceeds systematically, is overcome successfully if stable relationships, adaptive attitude to oneself and the world, healthy cognitive attitudes, stable emotional sphere took place in a woman's life before pregnancy ^{[5, 10]}.

However, most pregnant women face difficulties during the crisis period due to the presence of irrational cognitive attitudes that can cause intense emotional experiences of various modalities ^{[9, 11]}. In our study, we will focus on the disturbing aspects of understanding pregnancy that hinder successful adaptation. More and more people are turning to specialists with symptoms of anxiety disorders due to instability and low controllability of life. Moreover, pregnant women face maladaptive beliefs associated with the possible fragility and nonlinearity of the world. Their beliefs and anxious reactions can also be understood from the point of view of concern for their child, for their own health, as well as for further life and adaptation to new living conditions.

It is important to note that the percentage of affective disorders in the postpartum period is extremely high, so depressive episodes occur in 10-15% of women in labor, anxiety and panic disorders in 13%, and PTSD symptoms occur in 20% of women in the postpartum period ^{[21, 23]}. At the same time, due attention is not paid to these conditions. Moreover, timely diagnosis of predictors of these conditions, which are early maladaptive patterns and cognitive distortions, and further corrective measures, would help reduce the percentage of affective disorders among women in the postpartum period.

The aim of the study was to identify the interrelationships of the type of attitude to pregnancy and early maladaptive schemes of women in the conditions of a new coronavirus infection caused by COVID-19.

The subject of the study is the type of attitude to pregnancy in the conditions of a new coronavirus infection caused by COVID—19.

Scientific novelty of the study: theoretically justified and empirically proved the existence of relationships between the types of attitudes in the conditions of a new coronavirus infection caused by COVID-19 and early maladaptive schemes. Qualitative differences in the types of attitudes to pregnancy in women of different ages in the conditions of a new coronavirus infection caused by COVID-19 were determined.

Research methodology: typology of the psychological component of the gestational dominant I.V. Dobryakova, the concept of early maladaptive schemes J. Yang.

The hypothesis of the study was the assumption that there are correlations between the type of attitude to pregnancy and the actualization of early maladaptive schemes in women under the conditions of a new coronavirus infection caused by COVID-19

Empirical basis of the study: the study was conducted on the basis of the Altai Regional Clinical Center for Maternal and Child Health with women who are late in pregnancy (36-40 weeks). 168 women aged 18 to 40 participated in the study.

Table 1 presents the characteristics of the empirical base of the study.

Table 1. Description of the sample population

Thus, the age parameter was divided into three subgroups: under 25 years – 33.33% of the total sample, 26-30 years – 38.1% of the total sample, and 31-40 years – 28.57% of the total sample.

Research methods: methods of diagnosing early maladaptive schemes of J.Yang's "YSQ-S3R", "Pregnant woman's attitude test" (Eidemiller E. G., Dobryakov I. V., Nikolskaya I. M.).

Methods of mathematical and statistical data processing: one-factor analysis of variance ANOVA, Spearman correlation analysis.

According to the concept of I.V. Dobryakova, the type of relationship of a pregnant woman is determined by the psychological component of the gestational dominant. The psychological component of the gestational dominant, at the same time, is understood as a generalized system of mechanisms of regulation of the psyche, activated in a woman during pregnancy, and involved in the process of adaptation and formation of attitudes to pregnancy, childbirth and later to the child ^[5].

I.V. Dobryakov identifies five types of attitude to pregnancy: the optimal type is associated with an understanding of upcoming changes, a high degree of responsibility for both their health and the health and life of the child; the hypogestognosic type is associated with a lack of understanding of the importance, and an excessively light attitude to the ongoing changes in life; the euphoric type is characterized by a predominance of elevated mood, excessive an optimistic view of the upcoming changes, without taking into account possible negative consequences; the anxious type is associated with the predominance of health concerns, the presence of social conflicts and intrapersonal problems; and finally, the depressive type assumes a pronounced expression of anxious reactions, an excessively negative understanding of a new life role, hopelessness of the future ^[5].

In our study, attention is focused on the anxious and depressive types of attitudes towards pregnancy, as components most susceptible to transition into the category of affective disorders.

On the other hand, early maladaptive schemes, based on Jeffrey Young's concept, largely hinder a person's successful adaptation in society, interfere with personality formation and have a significant impact on the formation of cognitive distortions and maladaptive ways of responding ^{[20, 24]}. Thus, we can assume that the presence of certain maladaptive schemes will hinder the adaptive course of the gestational period. In this study, however, we will consider not so much maladaptive schemes as a whole, but rather an alarming component included in them, associated with a negative perception of the situation of a new coronavirus infection caused by COVID-19.

Many early maladaptive schemes include a component of anxiety, as mentioned earlier, moreover, including in the methodology for identifying these schemes, anxiety remains multidirectional, covering all possible beliefs that cause negative emotions.

In the methodology aimed at identifying early maladaptive schemes of J. Statements related to increased catastrophization and exaggeration of danger (such as "I am afraid that any wrong decision can lead to a catastrophe"), hypochondria (such as "I am worried that I am developing a serious illness, although doctors do not detect anything serious"), social anxiety (such as "I feel being an outsider in any group"), the uncontrollability of the world (etc. "I believe that something terrible can happen at any moment"). These statements, according to the cognitive-behavioral concept, can lead to the emergence of maladaptive anxiety reactions, which is why it is so important to consider them from the position of uncontrollability and anxiety of the world, including.

In order to analyze the differences in the types of the psychological component of the gestational dominant of pregnant women, depending on age, ANOVA single-factor analysis of variance was used, as a result, significant differences in the types of attitudes to pregnancy were revealed (the Shower Criterion ?0.05).

Table 2. Comparison of types of attitudes to pregnancy in groups of women of different ages

It is noted that in the age group up to 25 years, the level of severity of anxiety and depressive types of attitude to pregnancy is significantly higher than in the other two groups. This may be due primarily to a more unstable situation in the household organization of life, some infantile women. At the same time, the optimal type of gestational dominant was observed more often in the group of women aged 26 to 30 years.

For the purpose of further analysis, we considered the subjects included in the group of the anxious type of the psychological component of the gestational dominant. A correlation analysis was used between the anxiety type and individual statements from Jeffrey Young's methodology describing the uncontrollability, fragility and instability of the world, namely statements under the numbers 2, 17, 26, 35, 38, 44, 53, 62, 79, 89. To successfully combine these statements into a separate group, we have applied A dendogram using the Ward method.

This group of issues can be considered as "statements about instability, difficult controllability of the world", which is relevant in the situation of a new coronavirus infection caused by COVID-19.

Spearman's correlation analysis between the anxious type of the psychological component of the gestational dominant and statements about instability, difficult controllability of the world, revealed a significant correlation at the level (r =0.542, p=0.014).

Spearman's correlation analysis between the depressive type of the psychological component of the gestational dominant also revealed a significant correlation with beliefs about instability, difficult controllability of the world (r=0.567, p= 0.009). What can say that the more pronounced the beliefs about the instability, the difficult controllability of the world, the more likely a depressive type of attitude to pregnancy will form.

Moreover, the risk of developing postpartum affective disorders remains high, due to the presence of beliefs in thinking that prevent adaptation to new living conditions, complicating the perception of a new fragile, anxious, unstable reality. At the same time, the data obtained are of interest for further research. As noted above, the most pronounced type of anxiety response in women under 25 years of age, in further studies it seems relevant to analyze this pattern and understand what exactly the data obtained are related to.

Based on the conducted research , the following conclusions can be drawn:

1. Beliefs that are reliably associated with understanding anxiety and the fragility of the world have a positive correlation with anxious and depressive types of attitude to pregnancy.

2. The group of beliefs mentioned above forms a maladaptive response to stressful events in the life of a pregnant woman, which in turn affects both her psychological state in particular, and further interaction with the child, perception of herself in a new social role of the mother, and the formation of new maladaptive ways of responding to new living conditions after the birth of a child in general.  

3. Pregnant women under the age of 25 are more likely to worry about the possible fragility and uncertainty of reality than women of other age groups, which may be due to the actualization of early maladaptive schemes and the high level of infantilism of women of this age group.

Based on the research data, it seems important to further develop a correctional program for pregnant women, in order to adaptively comprehend the existing reality and accept the small controllability of the world as a whole.

Prospects for further research may be related to the study of differences in the type of attitude to pregnancy in women under the conditions of a new coronavirus infection caused by COVID-19, due to the presence of chronic diseases, complications in childbirth, the presence of children, characteristics of marital relations.

The results of this study may be useful for medical psychologists to organize a program of psychological support for pregnant women in terms of psychological education of women at the stage of pregnancy planning and preparation for childbirth in the conditions of a new coronavirus infection caused by COVID-19.